Chest pain and shortness of breath upon exertion

[Iluvmals]

Hello,

My husband is 45, does not smoke and not overweight.  For 10 years now (it has gotten progressively worse), he gets chest pain, like an elephant standing on his chest, shortness of breath and some weird heartbeats.  He had a cath 1 1/2 years ago and everything is fine.  He has not recreated it on a stress test, in the past a holter said they saw some irregularities but nothing to worry about.  He had a Nissen fundoplication for reflux last May.  These symptoms are brought on quicker after he eats.  Slow building up exercise, like for the stress hasn't done it.  The Cardiologist says its not his heart cause the test results have been OK.  I don't see how they can rule it out without witnessing an episode.  If he pushes it and does not stop he will pass out.  ( has once)

So, my question is.... Any ideas?????
Why can't they try the angina medication to see if it helps?

We are in the process of going to Mass General.
Anything specific we should ask for??

I think it may be microvascular angina or cardiac syndrome x, is that a possibility?

If you don't think its the heart, where would we go from here?
He has seen a pulmonologist and his lungs checked out fine.

Thank you very much, its nice to have someone help us all out when we're pretty much stumpted!!!!

Diane

[CCF-M.D.-MJM]

Hi Diane,

I understand your frustration.  It sounds like a difficult situation.  I assume he had a negative stress test before the cath.  The first thing I would do is an exercise stress test and try to catch the symptoms while on monitor.  I can't say it isn't microvascular angina or syndrome X, but these are difficult to diagnose.  Mass General is one of the best hospitals around.  They should be able to help.

Usually causes of recurrent exertional chest pains are cardiac, but they should be relativey easily reproducible with equivalent exertion.  If it occurs with variable levels of exertion, that makes it much less likely to be cardiovascular.  It is often easier to say what something is not than what it is. If it isn't his heart or lungs, I am not sure what else it could be.

I hope this helps.  Good luck when you visit Mass General.  Thanks for posting.

[Mantels]

I would get another cath. If it has gotten progressively worse it sounds like there has been a change.

[runnertom]

Could the pain be caused by ischemia due to diffuse disease of the coronary arteries? That may not show up on a cath and the stress test may not provide a long enough period of exertion to bring on symptoms.

[CCF-M.D.-MJM]

I forgot to mention, he should also have an echo to rule out valvular disease -- but I imagine this was already done.

[NanaRose]

The Heart Cath did not show up my problem BUT the Cardiac MRI did.  Not all centers have this sophisticated machine yet, but CC does and I am sure MassGeneral does also.  Also, I had an ECHOCARDIOGRAM and this was normal.  One month later this was repeated by another TECH (more experienced) and this time she picked up another problem.

Need very good interperters also.

Good Luck To You.

[NanaRose]

I also want to add that I wore a monitor for 48 hours and this picked up really nothing...Benign PAC's, I was told...I am now on a 30 day event monitor and the darn thing goes off when there is any irregularity it the ryhthm.  I am now picking up sustained and non sustained short and long runs of A-FIB.  This is what I have complained about also and now is surfacing with the right tests. I may be on my way to CC and or Mayo myself.  Mass General is great but a bit too far from where I live.

[ozark]

have they checked him for esophageal spasm??  this sometimes mimics chest pain ...look it up on the web for symptoms.  good luck

[Iluvmals]

Hi,

Thanks for reading.  We went to Mass General today (we lucked out and got in early due a cancellation!)

The Cardiologist has ordered a Thallium Exercise test to check for Microvascular angina.  Otherwise, he thinks his Acid Reflux surgery may have failed.  He did say he has a fast heartbeat.

He has him trying some acid reflux stuff, and is going to try a beta blocker, my husband has the name of it, starts with n.

I guess we'll know more in a couple of weeks,

Thanks Again,
Diane

[cdausman]

Anxiety attacks can sometimes mimic heart problems. Just a thought.